The Computerworld Honors Program
Honoring those who use Information Technology to benefit society
LOCATION:
Andhra Pradesh, India

YEAR:
2008

STATUS:
Laureate

CATEGORY:
Healthcare

NOMINATING COMPANY:
Satyam

ORGANIZATION:
EMRI

PROJECT NAME:
Emergency Response System in India



Introductory Overview
Despite recent economic advances, India is not a good country in which to suffer an injury. Hundreds of thousands of people are seriously hurt and/or perish in accidents in the country each year. Too many die simply because of time; hours sometimes elapse before accident victims arrive at a hospital.

Additionally, 12 percent of trauma care institutions have no access to ambulances, and only half of available ambulance services feature the facilities to treat victims during transportation. And only 4 percent of those who provide these services are formally trained emergency medical technicians and paramedics. Moreover, India lacks a single emergency phone number, unlike the U.S. (911) and the European Union (112). Consequently, precious time is lost while emergency numbers are looked up. Meanwhile, the need for quality emergency services continues to rise. Traffic accidents, crime resulting in injury, and birth-related emergencies, among others, increase every year.

Several years ago, Satyam Chairman Ramalinga Raju recognized the need for a state-of-the-art emergency response system to help injured people quickly. As a result, he and his brother, Ramu, formed the Emergency Management and Research Institute (EMRI), a not-for-profit entity that provides emergency management and training, and conducts research related to emergencies. The program’s goal is ambitious, yet simple: to become the world’s best emergency management organization.

To begin, EMRI registered with the government of Andhra Pradesh (AP) in an innovative public/private partnership. Then, EMRI officials approached the Government of India for a single, toll-free number. They were given 108, a number previously reserved for emergency and disaster management. Immediately, 10 million people in five major AP cities had access to enhanced emergency service by dialing 108. And every day, more people gain access.

EMRI and Satyam created a system that automates numerous critical call center activities: reaching the emergency site by vehicle (police, fire, medical); tracking ambulances (for medical cases); monitoring emergency care; informing police; and integrating voice-logging systems for audio replay. Additionally, EMRI makes a physician available in the call center at all times. It also operates 30 ALS and 40 BLS ambulances, which feature the latest technology and communications equipment, as well as extrication tools, fire extinguishers, rescue blankets, shovels, etc.

When someone calls 108 from within AP—from a fixed-line or mobile phone—the call is connected to a central site in Hyderabad, which handles medical, fire, and police emergencies. Calls are then routed to EMRI communications officers via Nortel’s Contact Center Manager Server technology.

The free solution is accessible 24 hours a day, by all AP residents, and handles more than 1 million calls per year, and saves thousands of lives every month. Additionally, it is taking root in other Indian states—quickly. By 2010, EMRI aims to be established throughout the subcontinent. At that point, it will likely save more than 1 million lives annually. Furthermore, the technology EMRI leverages continues to improve. While most ambulances feature telephone and radio contact to the doctor on duty in Hyderabad, a growing number are equipped with videoconferencing capabilities, enabling the physician to see patients—and get a better idea of the extent of their injuries—while they are en route to the hospital.

Because of these remarkable, rapid achievements, Satyam recommends EMRI to be recognized by the Computerworld Honors Program.

The Importance of Technology
How did the technology you used contribute to this project and why was it important?
Technology is obviously a critical element of an effort to establish a telephone-based emergency response program, and Satyam telecommunications professionals confirmed this during the design and build of the EMRI system and its architecture. Technology also plays a key role in the routing of calls, the dispatching of vehicles, and in the care provided on the way to a hospital.

In fact, technology is at the root of the entire EMRI emergency response system. Consider: When someone phones in an emergency via 108—from anywhere in Andhra Pradesh, and from a landline or cell phone—the call is connected instantly to a central site in Hyderabad, which handles medical, fire, and police emergencies through a Nortel Meridian1 Option 61C PBX. A Nortel Communication Server 1000 IP PBX immediately routes the call to one of EMRI’s Communications Officers using Nortel’s Contact Center Manager Server technology.

At the same time, a computer communication toolkit (CCT) passes a message with call details to the communication officer’s desktop application, and then creates an entry interface (a popup) with the caller’s location and details, enabling an agent to verify the address of the emergency. The communication officer determines the type of emergency and records details about the victim. Help is dispatched by either the medical or police dispatch officer.

Additionally, ambulance crews leverage geographic information systems and electronic maps to locate emergencies, while automatic vehicle location technology (AVLT) helps pinpoint the location of the nearest ambulance. Thanks to AVLT, dispatch officers can see ambulances move on their systems and provide directions to the pilot or driver based on the location of the emergency, expediting trips to emergency sites and to hospitals. Dispatchers can even suggest alternate routes if necessary.

Furthermore, interactions between callers and EMRI staff are recorded, and multi-party conference calls are possible, and can include the following: the caller, medical, police, fire dispatch officer, a medical doctor, and a supervisor. Finally, more and more EMRI ambulances feature videoconferencing technology, which enables doctors at the central location in Hyderabad, and at participating hospitals view patients on their way to medical facilities. This enables them to more clearly understand the care they will have to provide, and allows them to have paramedics provide more effective treatment en route.

SOLUTION ARCHITECTURE
EMRI’s application architecture is based upon advanced technologies such as Microsoft® ASP.NET, Microsoft .NET, and Windows® operating system–based client applications and services. The software is built using highly distributed components that enhance scalability and reliability.

Microsoft .NET version 1.1 helps build widely distributed applications. In this case, it provides interaction with other hardware, such as Nortel Switch, and applications such as the GIS-ESRI application for the client call manager application. Microsoft ASP.NET–based Web services provide functionality for various remote distributed applications. A Microsoft SQL Server™ 2000 database is used to store the applications.

A Windows service built for mailing SMS sends alerts and messages to mobile devices. A shared, third-party, well-managed mail server with SMTP service provides the gateway for sending e-mail messages for the core application. The client call manager application was developed using Windows Forms (the development library within the Microsoft .NET Framework for building rich Windows-based applications) to capture emergency call details. This information is communicated to the application using Microsoft.NET remoting client and remoting components, which are hosted on the remote server.

Furthermore, the system was implemented with the objective of 99.999 percent up-time, and features fault tolerance and backup provisions. It can also handle 200,000 emergency calls a day.

Benefits
Has your project helped those it was designed to help?   Yes

Has your project fundamentally changed how tasks are performed?   Yes

What new advantage or opportunity does your project provide to people?
Simply put, EMRI gives life. There can be no greater opportunity or advantage. Hundreds of thousands of people in India succumb to injuries each year. Huge percentages of these people would be saved if the entire country had emergency response systems similar to those in Western nations, such as the US, Canada, and most of Europe. In Andhra Pradesh, they do, fortunately, so thousands of people who probably would have died without Call 108—an estimated 12,098 in 2006 and 20,000 in 2007—have been saved.

In most of India, however, achieving emergency response is not as simple as dialing three digits. Police and fire departments and hospitals all have individual phone numbers, which vary from place to place. As such, people—often the injured themselves—must look up appropriate phone numbers, if they can, and call for help. Critical time is lost while numbers and land-line phones are found. Even more time elapses while emergency vehicles make their way to the people who need them.

Additionally, many people (notably a good number of the country’s 700 million people who live in poverty), are reluctant to call for emergency services, because they worry about costs. EMRI’s Call 108 service, however, is free. Asking for an ambulance is also free, as is a patient’s first 24 hours in an affiliated hospital. As a result, AP residents need not decide between feeding their families, for example, or receiving emergency care.

Moreover, the solution is not restricted to AP. As noted it is also being rolled out in other Indian states, including Madhya Pradesh and Gujarat. By 2010, EMRI aims to be able to serve the entire country—1.3 billion people.

Furthermore, as part of the program, Satyam is working with the Indian government to build roads and other important infrastructure elements in some of the poorer and more rural parts of the country. Obviously, these investments do more than facilitate ambulance access.

The solution has brought about entirely new and dramatically improved ways of responding to emergencies, especially in poorer areas of India. In addition, it has actually surpassed 911 and 112, from a comprehensive services standpoint. The approach integrates entire ecosystems—governments, private hospitals, diagnostic labs, pharmacies, insurance companies, telemedicine professionals, etc.—to expedite and improve the delivery of treatment to larger groups of people. At the same time, it reduces costs.


If possible, include an example of how the project has benefited a specific individual, enterprise or organization. Please include personal quotes from individuals who have directly benefited from your work.
The following quotes were taken from EMRI’s website, which features several case studies of people who have benefited from the program.

Emergencies can happen to anyone, anytime, anywhere … being a doctor myself, I had to use the services of EMRI. I had called 108 when my wife suddenly fell unconscious after a bout of convulsions. No amount of prompting could alert her, and the situation was going out of control. Suddenly, I remembered 108, as my son had mentioned once as a venture Satyam had started. I was apprehensive, as I was not sure how the response would be, but to my surprise the officer handled the call very well, asked for details, and within 10 minutes, an ambulance reached my place.

The paramedic handled the situation very professionally, and he, along with the driver, shifted my wife in a stretcher into the ambulance and got her admitted at Care Banjara. Being a doctor, I know the value of time when an emergency strikes, and that is the difference EMRI made.

Thanks to the people behind this project for saving the life of my wife, Laxmi.
Dr. A.V. Narasimha Rao

It was one in the morning when suddenly my mother’s sugar levels were going down and she started losing consciousness.

I immediately called Apollo and Remedy Hospitals for an ambulance, but both of them did not respond. Not knowing what to do, I called my brother in the U.S., and he suggested calling 108, as he had heard about Satyam venturing into emergency management.

Upon calling 108, the response was very quick, and within 10 minutes, the ambulance reached our place and the EMT immediately started treating my mother by checking her sugar levels and administering IV fluids.

We rushed her to Durgabhai Deshmukh, as suggested by the ambulance personnel, since that happened to be very near. The response at the hospital was also very quick since we came in through the services of 108.

I must admit that the timely intervention of the EMT saved the life of my mother, because the doctor in the hospital said had we been delayed, the chances of survival for my mother would have been bad.
Ms. Savithri
I was riding my bike near Kukatpally road around 2 o’clock in the afternoon. A lorry came and hit me from behind and I just realized that I was lying on the road in a pool of blood. Everyone around was reluctant to come forward to help. Suddenly a Good Samaritan came forward to help me and he remembered 108.

He called up 108 and the ambulance was on the spot within five minutes. The ambulance personnel immediately administered first aid in the form of IV fluids and splints, and shifted me to Remedy Hospital.

On reaching the hospital, the doctors informed me that if not for the timely intervention of the ambulance personnel applying the splints, it would have resulted in a major damage to my legs.

I am really grateful to the services provided by EMRI/108, which saved my life. I am looking forward to come in person and thank the whole team behind this noble cause.
Mr. Ravidra Reddy


Originality
Is it the first, the only, the best or the most effective application of its kind?   Most effective

What are the exceptional aspects of your project?
The EMRI’s Call 108 program is modeled after similar efforts in the US (911) and Europe (112), so it is not an original idea. However, its application in India is quite unique, owing to the country’s extremely crowded cities and overtaxed infrastructure.

The Satyam and EMRI team’s ability and bring the program to a scale able to serve all sections of the community, despite significant challenges, is also unique. Some of the challenges the team overcame include: legal, administrative, fire, police, single number, ambulance accreditation, paramedic training, and pre-hospital care.

It is an exceptional program for many reasons, foremost among them the fact that it saves so many lives. In addition, it goes beyond the programs it was modeled after. Thanks to its ability to identify the precise location of callers via GPS, is even more robust than 911, its North American counterpart. It enables police, paramedics, and doctors to work in synchronization as an ambulance is dispatched, ensuring exceptional treatment from the time care begins through recovery. Moreover, ambulances are extremely well equipped—they feature “telemedical” capabilities that allow doctors to see patients on a monitor as they are transported to the closest hospital in a vast network, facilitating fast, continuous, exceptional care.

The ambulances’ most valuable feature, however, may be the highly trained professionals who staff them. Newco paramedics are some of the world’s best, and save thousands of lives each year.

Furthermore, by continuously upgrading the service--videoconferencing capabilities are being added to ambulances as quickly as possible--EMRI becomes even more exceptional.



Difficulty
What were the most important obstacles that had to be overcome in order for your work to be successful? Technical problems? Resources? Expertise? Organizational problems?
Getting a program such as EMRI off the ground was indeed difficult, but not primarily because of technology issues. Satyam team members were confident they could handle those, and they did. The more daunting hurdles the team had to overcome had more to do with project management—getting a handle on the initiative’s scope and complexity while determining how to work within the region’s substandard infrastructure. Providing an emergency number for a state with 80 million people is obviously an ambitious undertaking, especially when one considers that AP, like many Indian states, features a broad range of populations—dense urban centers like Hyderabad, rural villages, and everything in between. Ensuring that people throughout the state could rely on the program required thorough commitment from Satyam and its team.

In addition, establishing the Call 108 program required considerable cooperation between Satyam and the AP government. And while the idea of a public/private partnership—such as the EMRI initiative—was not brand new to the region, Satyam definitely broke new ground with the project.

Other challenges Satyam had to overcome have been mentioned earlier in this document. They included legal and administrative hurdles—basically fighting though the red tape that typically accompanies an undertaking of such scope—as well as the problems encountered while linking the state’s police and fire departments to the single phone number. Additionally, the program required establishing relationships with 90 hospitals (a number than grows all the time)—facilities that agreed to treat emergency victims for no charge for 24 hours. Moreover, Satyam and its EMRI colleagues had to work hard to acquire and equip fleet of accredited ambulances (502 and counting in AP alone), and to ensure that these vehicles featured paramedics trained in pre-hospital care and other critical medical procedures.

Often the most innovative projects encounter the greatest resistance when they are originally proposed. If you had to fight for approval or funding, please provide a summary of the objections you faced and how you overcame them.
Other challenges Satyam had to overcome have been mentioned earlier. They included legal and administrative hurdles—basically fighting though the red tape that typically accompanies an undertaking of such scope and complexity—as well as the problems encountered while linking the state’s police and fire departments to the single phone number. Additionally, the program required establishing relationships with 90 hospitals (a number than grows all the time)—facilities that agreed to treat emergency victims for no charge for 24 hours. Moreover, Satyam and its EMRI colleagues had to work hard to acquire and equip fleet of accredited ambulances (502 and counting in AP alone), and to ensure that these vehicles featured paramedics trained in pre-hospital care and other critical medical procedures.

Success
Has your project achieved or exceeded its goals?   Exceeded

Is it fully operational?   Yes

How do you see your project's innovation benefiting other applications, organizations, or global communities?
Early on, when EMRI was clearly becoming a success that exceeded even the most optimistic predictions, leaders from the organization and Satyam established an extremely ambitious long-term objective: to become a nationwide program and save 1 million lives per year by 2010. So far, everything’s on schedule. People throughout AP have access to the service, and other states—Madhya Pradesh and Gujarat, for example—are implementing the Call 108 program. And discussions with other state governments are taking place.


EMRI is expanding rapidly throughout India, giving people from all communities access to swift, exceptional emergency healthcare service. Implementation in Andhra Pradesh has proved to be a superior prototype, a model being repeated in several other states already, such as Madhya Pradesh, with about 60 million people, and Gujarat, with more than 51 million. Again, by 2010, the entire country should have access to Call 108, at which point the lives saved every year will be in the millions.


How quickly has your targeted audience of users embraced your innovation? Or, how rapidly do you predict they will?
Call 108, EMRI’s emergency response number modeled after 911, has caught on very rapidly, to the point that in just a year, the entire state of Andhra Pradesh—80 million people—gained access to it. When two years of service are complete, the number will more than double.

Advertising on billboards, newspapers and other media, and even on ERMI ambulances themselves have helped spread the word about Call 108. However, because significant portions of the populations Call 108 serves lack regular access to media, word-of-mouth “advertising” has also proved invaluable in marketing the service. In short, as people hear about Call 108, they use it.

Digital/Visual Materials
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